Anesthesia E-ssential

AANA Anesthesia E-ssential, April 23, 2020

Vital Signs

SUPPORT THE FRONT: Free Virtual Mental Well-being Support for Healthcare Professionals

Committed to supporting the wellness and reducing stress of healthcare professionals serving on the frontlines of the COVID-19 pandemic, the Parkdale Center and the American Association of Nurse Anesthetists (AANA) have partnered to bring you “Support The Front.”

Join one of many free virtual support groups, and meet with peers to share common concerns and insights on dealing with trauma, stress, burn-out, recovery, and prioritizing self-care.

View the available topics and full schedule at
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AANA Releases Statement on Resuming Elective, Non-Urgent Surgical Procedures

The AANA has released a new position statement, Resuming Elective, Non-Urgent Surgical Procedures during the COVID-19 Pandemic, which supports lifting the prohibition of elective, non-urgent surgical procedures. The statement highlights additional important aspects to resuming patient care including provider rights to a safe working environment prior to return to work, healthcare providers receiving recognition for their contributions, an increase in compensation due to the risk of exposure, and the permanent removal of scope of practice barriers at the local, state, and federal levels.
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Transporting Anesthesia Workstations to Hospitals for Use as Ventilators

In an AANA Journal online exclusive article, Transporting Anesthesia Workstations to Hospitals for Use as Ventilators, Paul Austin, PhD, CRNA, and Michael Dosch, PhD, CRNA, describe factors to consider when transporting anesthesia workstations from an ambulatory surgical center for repurposing as a critical care ventilator in a hospital.

Stay current in your practice—access the most recent peer-reviewed COVID-19 related AANA Journal content at COVID-19 AANA Journal Articles.
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Board of Directors Approves an Updated Practice Document

In April 2020, the Board of Directors approved an updated practice document titled, Patient Safety: CRNAs and Health-Related Impaired Practice, Position Statement, Policy and Practice Considerations. The document encourages CRNAs with health conditions to be aware of their symptoms and potential treatment side effects and take appropriate measures, including seeking reasonable accommodation, to engage in safe patient care. The document also emphasizes the role of CRNAs in advocating for and collaborating in developing workplace policies, practices and supportive resources that prioritize patient safety and promote professional and personal well-being.
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CPC Application for Certification Renewal Now Open

The 2020 Continued Professional Certification (CPC) Application window for certification renewal is now open on the NBCRNA portal for CRNAs due to renew their certification by July 31, 2020—now extended to November 30, 2020. For this first CPC cycle, you will need 60 Class A credits and 40 Class B credits (or can use extra Class A credits over the required 60 towards the Class B requirement). Core Modules are not required in this first cycle. If you have all your requirements, visit to complete your application. Find all CPC information at
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SRNAs: Your Questions Needed for Upcoming SRNA Town Hall

Students have been uniquely affected by the COVID-19 pandemic. In order to help SRNAs with these specific challenges, the AANA is holding a 45-minute SRNA Town Hall on Monday, April 27, 2020, at 7 p.m. CT to help address students’ pressing questions and concerns. Staff from AANA, COA and NBCRNA, along with student representatives to various AANA committees, will serve on the panel and answer questions submitted by SRNAs from around the country. SRNAs, visit the SRNA Town Hall page to submit your questions by 12 p.m. CT, Friday, April 24 to have your voices heard!
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Call for Questions: Pediatric Anesthesia during the COVID-19 Pandemic

The AANA is in the process of developing a new webinar on the topic of pediatric anesthesia during the COVID-19 pandemic. In order to make this webinar informative, the webinar speakers would like to know what pressing questions you have on this topic. Please submit your questions through this form by April 27, 2020.
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AANA Partners with Hilton and American Express for You

The AANA is pleased to announce that it has partnered with Hilton and American Express in a nationwide program to provide CRNAs and SRNAs free hotel accommodations as you continue your fight against COVID-19.

Hilton and American Express are donating up to one million free hotel nights to frontline medical professionals, so you can have a safe and welcoming place to stay as you support those impacted by COVID-19. Bookings can be made for up to seven consecutive nights at a time and are currently open through May 9, 2020. The program will run through May 31, 2020, with rooms being added through the end of May on a rolling basis, subject to availability. Search available hotels and book here (Member login required).

On behalf of Hilton, American Express, the American Association of Nurse Anesthetists, our families, and communities—Thank You. Thank you for your dedication and perseverance. Your safety and well-being are important to the AANA, and we are proud to provide our members with this opportunity.

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POSTPONED: AANA State Leadership Workshop – Denver

In light of the current coronavirus pandemic, the decision has been made to postpone the AANA State Leadership Workshop scheduled for June 6-7, 2020, in Denver. The workshop will be postponed to a date next year, which has yet to be determined.

Registration fees will be refunded, and hotel reservations made within the AANA block will be canceled. We will keep everyone informed on any updates including the new date of the workshop. The health and safety of our members and staff remain the highest priority. Any questions may be directed to Luis Rivera at or (847) 655-1152.
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Hot Topics

Interested in Serving on a FY2021 AANA Committee? Application Deadline Extended

Deadline Extended: June 30, 2020
The deadline to apply for a position on a FY2021 AANA Committee has been extended! More information is available on the AANA Committee page. The application deadline is June 30, 2020.
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Deadline Extended: June 30, 2020 - FY2021 CRNA-PAC Committee

Deadline: June 30, 2020
CRNAs and SRNAs interested in serving on the CRNA-PAC Committee beginning in the AANA 2021 fiscal year are encouraged to submit an application through the AANA online committee submission form located on the committee page

Responsibilities of Committee members include:
  • Setting the CRNA-PAC income and expenditure policy;
  • Participating in fundraising duties;
  • Reviewing open-seat and challenger candidates for federal office; and
  • Volunteering at CRNA-PAC events and national meetings.
Committee members are expected to attend two in-person meetings per year (Joint Committee Conference in September 2020 and Mid-Year Assembly in April 2021) and conference calls on an as-needed basis.

If you have any questions, please contact Catharine Harris, AANA Associate Director of Political Affairs, at or call (202) 741-9087.

The following is an FEC required legal notification for CRNA-PAC: Gifts to political action committees are not tax-deductible. Contributions to CRNA-PAC are for political purposes. All contributions to CRNA-PAC are voluntary. You may refuse to contribute without reprisal. The guidelines are merely suggestions. You are free to contribute more or less than the guidelines suggest, and the association will not favor or disadvantage you by reason of the amount contributed or the decision not to contribute. Federal law requires CRNA-PAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. Each contributor must be a U.S. Citizen.

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Students and CRNAs Needed for the Anesthesia College Bowl!

Applications Deadline: May 4, 2020
The spirited Anesthesia College Bowl will be held at the 2020 AANA Annual Congress on Monday, August 17, 2020. Six teams of students compete against each other, answering questions about anesthesia that have been submitted by nurse anesthesia program directors. The winning student team faces off against a team of six CRNAs to determine the ultimate winner of the College Bowl. The winners hold bragging rights until the following year! Applications for both students and CRNAs are due May 4, 2020.

Students wishing to play must inform their program administrator, who can submit a maximum of two students to participate. CRNAs must submit the Challenge Team sign-up form. Please visit the AANA website for complete details under Education Opportunities for Educators.
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Student Representative to the Education Committee - Deadline: May 4

Applications Deadline: May 4, 2020
The AANA Education Committee supports the professional development of nurse anesthesia didactic and clinical educators and students. The committee includes a student representative, elected annually, who serves for one year. This student functions as an information source for students and enhances communication between the student body and the committee. In addition to participating in the above activities, the student representative facilitates the AANA Connect SRNA Community, contributes content to the AANA for SRNAs Facebook page, and writes the Student News column for the AANA NewsBulletin.

The student representative is elected by the students attending the AANA Annual Congress. The student representative participates in Education Committee meetings and conference calls. Please visit the AANA website for complete details under CE & Education > Education > Opportunities for Students. Note that your expected graduation date must be August 2021 or thereafter. The deadline for submission is May 4, 2020.

Primary activities of the Education committee include planning the Assembly of Didactic and Clinical Educators (ADCE) meetings and the Student Session at Annual Congress. The committee also hosts the Student Luncheon and Anesthesia College Bowl at Annual Congress.

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NewsMakers: CRNAs Ben and Mindy Cayer Bring Hope, Inspiration to COVID-19 Fight

With one photo, husband and wife CRNAs Ben and Mindy Cayer have become the face of healthcare providers on the frontlines of the COVID-19 fight. Some of the press they have garnered due to the iconic photo taken by Nicole Hubbard, CRNA, chief nurse anesthetist at Tampa General Hospital in Tampa, Fla., includes:
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AANA Meetings: Refresh Your Knowledge and Make New Connections

Free Virtual Symposium: Innovation in Person-Centered Pain Management

As a member of the Alliance to Advance Comprehensive Integrative Pain Management (AACIPM), AANA is pleased to share the opportunity for our members to join the exciting virtual symposium, Innovation in Person-Centered Pain Management, on May 13-14, 2020. This event is a modified version of the Pain Policy Congress (PPC) that was to be held in Kansas City. Featuring more than 30 renowned speakers and advisors, the virtual symposium continues our collective action around shared priorities.

Space is not limited so you can register and share it with your networks. Join all or part of these informative sessions. Recordings of each session will be shared after the meeting. Learn more and register today.
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Six FREE Webinars: Stay Current with the Latest COVID-19 News and Resources

AANA and its partners are hosting several webinars to provide our members with the latest news and resources on COVID-19. Please see our upcoming schedule below:
  • Thursday, April 23 at 1 p.m. CDT: Webinar: Infection Prevention Pearls. Learn COVID-19 infection prevention measures during anesthesia care of COVID-19 patients. Earn 1.0 Class A CE Credit. Register here.

  • Friday, April 24 at 5 p.m. CDT: Webinar: Peer Support, Self-care, and Resilience for Health Care Providers during COVID-19. The fear and anxiety caused by COVID-19 that healthcare professionals are experiencing can be overwhelming and can cause strong emotions. Learn insight and wisdom on how best to take care of yourself and support your fellow care professionals. Presenters: Maria Van Pelt, PhD, MSN, MS, CRNA; Josh Lea, DNP, MBA, MS, CRNA; Lauren LaChance, RN. Earn 1.0 Class A CE Credit. Register here.

  • Monday, April 27, 7 p.m. CDT: YouTube Live Video: SRNA Town Hall addressing frequently asked questions of SRNAs presented by Adrianna Silva, BSN, RN, CCRN, Student Representative to the AANA Education Committee; the COA; and NBCRNA. Join us on AANA’s YouTube channel.
  • Tuesday, April 28 at 5 p.m. CDT: Webinar: Impact of Drug Shortages During the COVID-19 Pandemic: Learn of the causes and implications of current drug shortages and how they impact clinical practice, particularly for drugs needed in the critical care of ventilated COVID-19 patients. Presenters: Erin R. Fox, PharmD, BCPS, FASHP; Daniel Kistner, PharmD; David J. Margraf, PharmD, MS; Brian D. Berry Jr., CRNA, MBA, MS; and Lorraine Jordan, PhD, CRNA, CAE, FAAN. Register here.

  • Wednesday, April 29 12 p.m. CDT: Webinar: Student Loan Repayment During Uncertain Times - Presented by Laurel Road. In this webinar exclusively for AANA members, Laurel Road will share more information on the federal response to student loans during the COVID-19 crisis, considerations in your decision to refinance, and some available student loan repayment options. Register here.

  • Planning/In Process:
    Thursday, April 30 at 6 p.m. CDT, Town hall to update the membership regarding AANA's response to COVID-19. More information and a link coming soon.
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Foundation and Research

AANA Foundation Open Submission: Dean Hayden Student Research & Evidence-Based Practice Grant

This grant is open to student registered nurse anesthetists (SRNAs) who are nurse anesthesia students in good academic standing and an associate member of the AANA. Visit the Foundation’s Applications and Program Information webpage to learn more and apply.
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AANA Foundation: Grant Applications – Due May 1, 2020

The mission of the AANA Foundation is to advance the science of anesthesia through education and research. Grants are awarded to CRNAs only and the applicant must be an AANA member. The AANA Foundation sets a broad research agenda that includes healthcare policy, science of anesthesia, education, practice/clinical, and leadership. Visit the AANA Foundation website to learn more and apply. Grant applications are due May 1, 2020.
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AANA Foundation: ‘State of the Science’ Oral and General Poster Sessions Application Now Available – Due May 1, 2020

The ‘State of the Science’ Oral and General Poster Sessions offer CRNAs and SRNAs an opportunity to present their research findings and innovative educational approaches at the AANA Annual Congress in San Diego, Calif., August 14-18, 2020. Research, literature reviews, and innovative, creative techniques in anesthesia are appropriate topics. Access the applications on the AANA Foundation website. Apply today!
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AANA Foundation: Call for Board of Trustees Candidates - Deadline June 1, 2020

The AANA Foundation is seeking candidates for its Board of Trustees. If you are interested, review the criteria and apply by June 1, 2020. Thank you.
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AANA Foundation: ADCE Thank You Video

Thanks to all who attended the AANA Foundation’s fundraiser at the Assembly of Clinical and Didactic Educators (ADCE) – Uncork & Unwind. We appreciate your support. Check out this video for great photos of those in attendance.
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AANA Member Benefits

Medtronic and Allego Jointly Announce Ventilator Training Alliance Launch

AANA Corporate Partner Medtronic and Allego jointly announce the launch of the Ventilator Training Alliance (VTA). The alliance is an industry-wide effort to provide healthcare professionals one central location for training across many ventilator models. To date Dräger, GE Healthcare, Getinge, Hamilton Medical, Nihon Kohden, and Philips have joined Medtronic to form this alliance. Several companies are actively in the process of joining the alliance and will continue to do so over the next couple of weeks.

The VTA app:
  • Meets the need for ventilator training due to new manufacturers and increasing shortages in respiratory therapists during the COVID-19 crisis.
  • Connects respiratory therapists, nurses, and other medical professionals to training resources.
  • Provides offline capabilities and multi-language closed captioning.
  • Visit the VTA app demo to learn more or check the joint press release from Medtronic and Allego, which is the technology platform building and hosting the app.
Download the app from the Apple App Store or Google Play Store.

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Members, Take Advantage of Free Class A and Pharmacology Credits!

Earn up to 9.5 Class A CE and 1.75 pharmacology credits with exclusive AANA Learn® courses, including topics like enhanced recovery, respiratory compromise, and multimodal pain management. Free to AANA members and associate (student) members—just log in and add the course(s) to your cart. Get started today!
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Laurel Road Offering Specialized Rates for Nurses

To thank you for all that you do, Laurel Road is providing Nurse Anesthetists with specialized rates when refinancing1, to hopefully make your life a little easier.

As an AANA member, you are also eligible for a $250 cash bonus2 when you refinance your student loans with us. Plus, you could get your new preliminary rate in as little as 5 minutes.

Learn more and check your rate.

All credit products are subject to credit approval.
  1. Special pricing is available to nurses with the following degrees: Master in Nursing, Doctor of Nursing, Associate in Nursing, MA/MS/PhD in Nursing, Associate of Science Degree in Nursing (ASN), Bachelor of Science in Nursing (BSN). Not available to residents, fellows, or students.
  2. The AANA $250 cash bonus is offered for applications from active AANA members. The loan application must close in order to qualify for the bonus. Cash bonuses will be paid within 45 days of closing. Offer cannot be combined with other offers, except for any discount for making automatic payments. Existing customers are not eligible.
Laurel Road is a brand of KeyBank National Association. All loans are provided by KeyBank. Member FDIC.
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Explore Resources for Respiratory Compromise, Ventilation, Brain Health Monitoring

AANA Corporate Partner Medtronic has a vast library of tools and resources available for clinicians needing information on ventilators and other devices supporting respiratory compromise and brain health monitoring. They are here to support you as you take on patient care at this unprecedented time. Check out these resources:
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CRNACareers - What are your next steps?

Whether you’re graduating soon and researching employers, are a seasoned professional interested in advancing your career or looking to supplement your work with locum tenens options, is the place to help get you started:

  • Search and apply to locum tenens or permanent positions at industry-leading facilities.
  • Upload your resume anonymously and allow employers to contact you.
  • Set up job alerts to receive notifications on new openings.
  • Access free career resources to assist with resume and interview preparation.

Learn more today!

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Director of Nurse Anesthesia, Mount Marty College, South Dakota

Mount Marty College is currently accepting applications for Director of the DNAP program at Mount Marty College-Sioux Falls. The Director will have oversight of the DNAP curricular programming, supervision of faculty and staff and assure compliance with regulatory bodies.

Minimum qualifications: Earned terminal degree, 5 years CRNA clinical experience, RN license to practice nursing in South Dakota. Prior experience in teaching (clinical or didactic) and a record of relevant research and scholarship. Prior administrative or managerial experience in the clinical or educational arena.

Required characteristics:
  • Interpersonal/human relations skills with ability to relate to diverse groups.
  • Demonstrates strong management and organizational skills.
  • Develops and implements long-term vision and goals in alignment with the institution's strategic plan.
  • Strengthens the program to support personal and professional growth of students and faculty.
  • An ability to focus on the future of nurse anesthesia practice and accreditation standards and willingness to generate reports as required to meet institutional and regulatory standards.
The DNAP Director reports to the Dean of Nursing and Health Sciences at Mount Marty College and is a member of the Graduate Council. Learn more.
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CRNA: Envision Healthcare, New York

New York Needs You
Please join our urgent mission to treat those afflicted by COVID-19 in one of our nation’s hotspots, New York. Envision is partnering with several hospitals and health systems to provide healthcare resources in the form of intensive care unit (ICU) staffing. We anticipate additional opportunities throughout the Tri-State Area.

We are looking for CRNAs who are willing to work as an ICU nurse, helping to care for patients. With New York declaring a state of emergency, the health system will accept active state medical licenses from any state in the U.S. Our Clinical Leader leading this initiative has strong peace- and war-time experience and extensive experience in working with CRNAs.

Some of the defined duties include:
  • Intubation and advanced airway management.
  • Ventilator management and troubleshooting.
  • Sedation ordering/dosing/administration for vented patients.
  • Central-line insertion.
Additional responsibilities:
  • Rounding with a medical team.
  • Family communication.
  • Weaning and extubation.
  • Documentation in EMR-EPIC.
Assignment Details:
  • 12-hour shifts — days and nights.
  • Transportation, lodging and food accommodations provided.
  • Concierge personnel to support your travel.
  • Recommended PPE will be provided.
  • Work as an independent contractor with competitive compensation.
  • 4-week commitment preferred.
Learn more.
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CRNA: St. Mary's Hospital, Wisconsin

SSM Health Dean Medical Group, a 450+ physician multi-specialty group, is actively recruiting a CRNA (.80-1.0 FTE) to join our anesthesia department at St. Mary’s Hospital in Janesville. We recently opened a new, state-of-the-art hospital and clinic building. The department currently consists of 4 physicians and 9 CRNAs. St. Mary’s Janesville Hospital has 7 operating rooms which includes one that is dedicated to c-sections. Typical case load includes general surgery, orthopedics, OB, ENT and healthy pediatrics. The call schedule will be 1:7.

The new medical campus in Janesville opened in 2012. It includes the 50-bed St. Mary's Janesville Hospital and the connected Dean Medical Group physician offices and medical complex. The hospital provides health care services from Urgent Care to ICU, and a recently added on-site radiation oncology facility. It also benefits from being part of the greater SSMHC/Dean system, with the sister hospital, St. Mary’s Hospital in Madison, just 35 miles north of Janesville. Electronic medical records are also seamlessly connected throughout the hospital, clinic, and the entire Dean system via Epic.

  • NBCRNA certification, WI licensure.
Learn more.
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CRNAs: Duke University Hospital, North Carolina

We have immediate opportunities for CRNAs to join our growing teams. With 957 inpatient beds, here you will find comprehensive diagnostic and therapeutic facilities including a regional emergency/trauma center; a major surgery suite containing 51 operating rooms; an endo-surgery center; an ambulatory surgery center with nine operating rooms and an extensive diagnostic and interventional radiology area.

Duke University Hospital includes the following specialties, each offering new and exciting opportunities in both adult and pediatric using the latest technological advancements. These advancements include two intraoperative MRI suites and two intraoperative CT suites.
  • General Surgery
  • Cardiothoracic
  • Orthopedics
  • Plastics
  • Neurosurgery
  • Otolaryngology Head & Neck (ENT)
  • Gynecology
  • Urology
  • Robotics
  • Transplant
U.S News & World Report named Duke University Hospital #1 in North Carolina and #1 in the Raleigh-Durham area in 2018-19. Duke University Hospital is ranked in the top 20 nationally for seven adult specialties, including cardiology and heart surgery, nephrology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology.

To be considered, we require a master's degree from a nurse anesthesia program, a current or compact RN licensure in North Carolina, and NBCRNA certification. Learn more.
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Healthcare Headlines

Healthcare Headlines is for informational purposes, and its content should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

Association Between Preoperative Obstructive Sleep Apnea and Preoperative Positive Airway Pressure with Postoperative Intensive Care Unit Delirium

With a single U.S. hospital as their backdrop, researchers explored the possible ties between obstructive sleep apnea (OSA), positive airway pressure, and postoperative delirium in the intensive care unit (ICU). Specifically, the team wanted to understand if preoperative OSA is associated with incident delirium postoperatively in the ICU and whether preoperative positive airway pressure attenuates this relationship. Their retrospective study included 7,792 patients who were admitted to the ICU following major surgery under general anesthesia. Confirmed or suspected OSA occurred in 26 percent of the sample population, while delirium was documented in 47 percent. Although OSA has previously been linked to postoperative delirium, the new findings found no significant correlation between OSA and postoperative delirium in patients admitted to the ICU after major surgery—even after risk adjustment. The researchers were also unable to establish an association between positive airway pressure adherence and delirium. Therefore, they concluded, interventions targeting OSA and positive airway pressure probably will not have a meaningful effect on postoperative delirium in the ICU.

From "Association Between Preoperative Obstructive Sleep Apnea and Preoperative Positive Airway Pressure with Postoperative Intensive Care Unit Delirium"
JAMA Network Open (04/20/20) King, Christopher R.; Fritz, Bradley A.; Escallier, Krisztina; et al.

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Ultrasound-Guided Erector Spinae Plane Block for Postoperative Analgesia

Researchers performed a meta-analysis of ultrasound-guided erector spinae plane block (ESPB), which more patients are receiving to manage post-surgical pain. They included a dozen randomized controlled trials that compared the technique with a control or with placebo. The collective study population included 590 adults having surgery under general anesthesia. Based on intravenous opioid requirement 24 hours postoperatively—which was lower with ultrasound-guided ESPB—the meta-analysis demonstrated the clinical efficacy of the intervention for pain relief following an operation. In addition to the primary endpoint, ESPB was associated with a reduced need for postoperative analgesia and a longer time to first rescue analgesia.

From "Ultrasound-Guided Erector Spinae Plane Block for Postoperative Analgesia"
BMC Anesthesiology (04/14/20) Vol. 20, No. 83 Huang, Jiao; Liu, Jing-Chen

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Combined Non-Intubated Anesthesia and Paravertebral Nerve Block vs. Intubated Anesthesia in Children Undergoing Video-Assisted Thoracic Surgery

Researchers in China wondered if using paravertebral nerve block (PVNB) in conjunction with non-intubated anesthesia would improve outcomes in children recovering from video-assisted thoracic surgery (VATS). To investigate, they enrolled 60 VATS patients between the ages of three and eight years old for a randomized controlled trial. Half underwent the procedure with non-intubated anesthesia plus PVNB, while the other half received general anesthesia with tracheal intubation. Compared with the controls, children in the intervention group were hospitalized for a shorter period of time—which was the primary outcome of interest. Secondary endpoints—including the incidence of emergence delirium, emergence time, duration in the postoperative care unit, time to first feeding, time to first out-of-bed activity, pain score, and postoperative use of sufentanil—also favored PVNB coupled with non-intubated anesthesia. The approach additionally was associated with fewer airway complications compared to the traditional technique. While the results are promising, the investigators recommended multi-site studies to validate their findings.

From "Combined Non-Intubated Anesthesia and Paravertebral Nerve Block vs. Intubated Anesthesia in Children Undergoing Video-Assisted Thoracic Surgery"
Acta Anaesthesiologica Scandinavica (04/03/2020) Wei, Wei; Fan, Yanting; Liu, Wei; et al.

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Factors Associated with Minimum Effective Volume of Lidocaine 1.5% for Sciatic Nerve Blocks

To determine the individual factors associated with minimum effective volume (MEV) of lidocaine 1.5% during ultrasound-guided popliteal sciatic nerve block (SNB), 40 patients were recruited for a prospective study. All participants received combined single-shot femoral nerve block (FNB), completed with 15 mL of lidocaine 1.5%. One half-hour after FNB, a loading dose of 5 mL of lidocaine 1.5% was administered to block the sciatic nerve. Additional doses were administered at intervals until the maximum compound muscle action potential approached zero. The MEV of lidocaine 1.5% for complete SNB ranged from 7 to 15 mL, with concentrations of the anesthetic and its metabolites never reaching toxic levels—which demonstrates the safety of combined FNB/SNB. Cross-sectional nerve area, meanwhile, was the only individual factor with a significant correlation to MEV of lidocaine 1.5%. No association was observed based on age, gender, body mass index, or depth of the sciatic nerve.

From "Factors Associated with Minimum Effective Volume of Lidocaine 1.5% for Sciatic Nerve Blocks"
Clinical Journal of Pain (04/20) Vol. 36, No. 4, P. 296 Chen, Xiaorui; Ling, Dandan; Cao, Jianfang; et al.

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Adductor Canal Versus Femoral Nerve Block After Anterior Cruciate Ligament Reconstruction

A systematic review of the literature compared adductor canal block (ACB) to femoral nerve block (FNB) in the setting of primary anterior cruciate ligament reconstruction (ACLR). Researchers from the University of Colorado School of Medicine identified five randomized controlled trials that matched their criteria for inclusion, with a total of 221 patients who underwent the procedure with ACB and a like number who received FNB. In the study results, they looked at between-group differences in pain and functional outcomes. Based on the evidence, ACB appears to generate comparable postoperative analgesic demand as FNB in the first 24 hours, but ACB may be more effective in preserving muscle strength in the quadriceps at 24 to 48 hours after surgery. However, the reviewers concluded, the differences in muscle strength assessments between studies do not allow for strong conclusions.

From "Adductor Canal Versus Femoral Nerve Block After Anterior Cruciate Ligament Reconstruction"
Arthroscopy (04/18/20) Smith, John-Rudolph H.; Belk, John Wilson; Kraeutler, Matthew J.; et al.

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Pharmacokinetics and Pharmacodynamics of Remimazolam After Continuous Infusion in Healthy Male Volunteers

A small study out of Germany explored the electroencephalogram (EEG) pharmacodynamics of remimazolam for intravenous sedation. A sample of 20 healthy men received a continuous infusion of the new ultra-short acting benzodiazepine, which mediates fast initiation of deep sedation as well as rapid recovery from it. Both the Narcotrend Index and a neurophysiologic system with electrode placement were used to conduct continuous EEG monitoring of the study volunteers. EEG changes during remimazolam infusion reflected an initial increase in beta frequency band and a later increase in delta frequency band. Beta ratio was a better variable for monitoring remimazolam sedation than Narcotrend Index based on a prediction probability score of 0.79 versus 0.74, respectively, on the Modified Observer's Assessment of Alertness and Sedation scale. The researchers also determined that beta ratio could be modeled successfully using a standard sigmoid Emax pharmacodynamic model.

From "Pharmacokinetics and Pharmacodynamics of Remimazolam After Continuous Infusion in Healthy Male Volunteers"
Anesthesiology (Spring 2020) Vol. 132, No. 4, P. 652 Eisenried, Andreas; Schüttler, Jürgen; Lerch, Marco; et al.

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News summaries © copyright 2020 SmithBucklin

Anesthesia E-ssential is an executive summary of noteworthy articles of interest to nurse anesthetists. It is distributed weekly to AANA members.

Anesthesia E-ssential is for informational purposes, and its contents should not be interpreted as endorsements, standards of care, or position statements of the American Association of Nurse Anesthetists.

If you are interested in advertising in Anesthesia E-ssential contact HealthCom Media at 215-489-7000.

For more information on AANA and Anesthesia E-ssential, contact:

222 S. Prospect Avenue
Park Ridge, IL 60068
Phone: (855) 526-2262 (toll-free)/(847) 692-7050
Fax: (847) 692-6968

Attn: Cathy Hodson
E–ssential Editor
April 23, 2020